AST:ALT
ratio of more than 2:1 is characteristic in patients with alcoholic liver disease

a raised AST level out of proportion to the ALT level appears to be caused by
a differential reduction in hepatic ALT due to deficiency of the cofactor pyridoxine-5-phosphate

AST:ALT ratio of more than 2:0 is suggestive of alcoholic liver disease
- however this result does not preclude other diagnoses

a raised ALT level
to more than 500 IU/L suggests a diagnosis other than alcoholic liver disease,
even if the AST:ALT ratio is greater than 2:0

other blood tests also suggestive
of the presence of alcoholic liver disease include raised of serum gamma-glutamyltranspeptidase
(GGT) level and mean corpuscular volume

in viral viral
hepatitis

the AST:ALT ratio, which is typically less than 1:0 (particularly
true in patients with hepatitis C), can rise to greater values as fibrosis and
cirrhosis develop

exact mechanism of AST:ALT ratio alteration in progression
of liver disease is unclear, and the correlation with and accuracy in predicting
degree of fibrosis and presence of cirrhosis are controversial

in
many forms of acute and chronic liver injury or steatosis (fatty infiltration
of the liver), the ratio is less than or equal to 1

study of 140 patients
with nonalcoholic steatohepatitis (NASH; confirmed by liver biopsy) or alcoholic
liver disease found a mean AST/ALT ratio of 0.9 in patients with NASH and 2.6
in patients with alcoholic liver disease (2)

within the study population

87 percent of patients with an AST/ALT ratio of 1.3 or less had NASH (87 percent
sensitivity, 84 percent specificity)

severity of NASH as measured by
the degree of fibrosis increased, as did the AST/ALT ratio

mean ratio
of 1.4 was found in patients with cirrhosis related to NASH

Wilson's
disease can cause the AST/ALT ratio to exceed 4 (3)

In
conclusion

AST:ALT ratios are suggestive of certain conditions

there is significant overlap between AST:ALT ratios in different conditions

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